Fred Boothby, CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704142595 Issued in MI

Practice address

3285 122ND Ave
P.O. Drawer 130
Allegan, MI 49010-9511

Phone

(269) 673-6617

Fax

(269) 673-2738

NPI assigned

Nov 14, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Otsego Family Medical Practice, PLLC

  • Family Nurse Practitioner
  • Gobles, MI
  • NPI 1801920533

  Nurse Practitioner

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787529600000",
    "number": "1962483271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3285 122ND AVE",
            "address_2": "P.O. DRAWER 130",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490109511",
            "telephone_number": "269-673-6617",
            "fax_number": "269-673-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3285 122ND AVE",
            "address_2": "P.O. DRAWER 130",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490109511",
            "telephone_number": "269-673-6617",
            "fax_number": "269-673-2738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTHBY",
        "first_name": "FRED",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2026-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704142595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4699274",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5008704740",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mohamed A Beydoun, PHARMD
• Brian Denton Bigelow
• Marcus Blass, MD
• Shenise Marie Blue
• Kathryne Boerman, MSW
• Alexia Bordeau, LLMSW, BSW
• Makenna Bos, BCBA
• Kimberly Renee Bouchard, RN, AEMT
• Michelle Boutain, CHW
• Jack Douglas Bower, PTA

• All providers in Allegan, MI
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.